Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Some sports authorities say the drug is now finding a following among athletes.

The World Anti-Doping Agency is currently studying Viagra's effects in athletes, but hasn't yet banned it. Experts are divided over whether it actually offers athletes an edge.

"It's possible," said Anthony Butch, director of the Olympic Analytical laboratory at the University of California Los Angeles, a WADA-accredited facility.

Viagra, also known as sildenafil, is manufactured by Pfizer Inc. It was originally developed as a heart drug; its use as a treatment for erectile dysfunction was only accidentally discovered.

The drug works by increasing the effects of nitric oxide, which makes blood vessels expand. That should theoretically allow blood cells to travel to the lungs more efficiently and to also receive more oxygen. It may also improve heart function.

Viagra is also approved to treat pulmonary hypertension, a condition where the lungs' blood vessels tighten. Doctors have used the drug experimentally to treat pregnant women with high blood pressure and to ward off jet-lag.

"Just because you have more nitric oxide doesn't mean that you are going to be a better athlete," Butch said. "If you have all the nitric oxide you need, and if you generate more from Viagra, it's not clear what effect that would have."

Still, some preliminary studies have shown that cyclists taking Viagra improved their performances by up to 40 percent.

"If you have more oxygen going to your muscles, that's more energy and that makes you a better athlete," said Dr. Andrew McCullough, a sexual health expert at New York University School of Medicine. "Even if it only gives you a 10 percent increase, in peak athletes, that is enough to win," he said.

McCullough said Viagra is only likely to help athletes like runners, cyclists or skiers — sports where endurance and speed are key. Viagra does not work directly on muscles, so will not make athletes physically stronger.

Athletes often mistakenly assume that a drug will work in their bodies the same way it does in sick people.

For instance, in people with lung problems who take Viagra, the drug widens their blood vessels so they can absorb more oxygen.

"Viagra corrects problems in people who are in a challenged or diseased state," said Ian McGrath, a professor of physiology at the University of Glasgow. In normal people, the body's own regulating system is not so easily superseded by drugs, and taking Viagra may be useless, McGrath said.

Still, if Viagra does give athletes an unfair advantage, they will be able to take it at the upcoming Beijing Olympics without worry, since it is not on the prohibited list of medicines.

McGrath said taking Viagra could theoretically help people breathe better in heavily polluted cities, like the Chinese capital. "If you have some sort of illness from pollution, then Viagra might help," he said.

Many scientists at laboratories that conduct drug testing say they haven't noticed a suspicious spike in samples containing Viagra.

"We see it as much as we see ibuprofen or aspirin or antibiotics that are not prohibited," said Christiane Ayotte, director of a WADA-accredited laboratory in Canada. "Athletes may be taking it, but they may be taking it for non-doping purposes," she said.

Sexual exemptions?
Ayotte thinks it would be unrealistic to ban Viagra. "Are athletes going to have to submit therapeutic-use exemptions for Viagra?" she asked. "That would be quite humiliating."

Other doctors hypothesized that Viagra's more well-known effects on men's sex lives might be the ultimate explanation for any enhanced athletic abilities.

"It could be that athletes are taking Viagra and then having vigorous sexual activity," said Dr. Gerard Varlotta, director of sports rehabilitation at New York University's Rusk Institute of Rehabilitation Medicine. Varlotta doubted that Viagra itself could improve an athletes' performance.

"If athletes are euphoric after sex after taking Viagra, they may be euphoric about their athletic endeavors," Varlotta said. "That may make them a better athlete."

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